EmailMe Form - Unpleasant Experience

Location *

Fatburger

Date of Visit *
MM / DD / YYYY HH : MM AM/PM
Name *
First Last
Address

Street Address City State / Province / Region Postal / Zip Code Country / Region
Phone
Email *
mail@example.com
How likely is it you would recommend us to friend? *

Not at all likely
1

2

3

4

5

6

7

8

9

10

Extremely likely
Why?
How frequently do you visit Fatburger?
First visit
1-2 visits per month
3-5 visits per month
5+ visits per month
Do you live in the area?
1-2 miles
3-4 miles
5+ miles
No
How did you hear about us?
Radio / TV
Word of mouth
Digital Advertisement
Social Media
Driving by
Billboard
Print
Details about your experience:
Customer Service *

Worst
1

2

3

4

5

Best
Product Quality *

Low
1

2

3

4

5

High
Accuracy of Order *

Worst
1

2

3

4

5

Best
Product Timeliness *

Slow
1

2

3

4

5

Fast
Overall Experience *
Subject of Feedback
Additional Comments
Image Upload

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